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pancreas and spleen Flashcards

1
Q

where does the spleen lie

A

in the leaf of greater omentum

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2
Q

what attaches the spleen to the stomach

A

gastrosplenic ligament

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3
Q

nodular lymphoreticular tissue

A

white pulp

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4
Q

what part of the parenchyma is the site of immune response in the spleen

A

white pulp

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5
Q

this section of the spleen stores RBC and traps antigens

A

red pulp = venous sinuses

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6
Q

calcium/iron deposits on the spleen - normal finding

A

siderotic plaques

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7
Q

accessory spleen

A

incidental ectopic tissue

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8
Q

usually from seeding of cells after trauma or sx

A

splenosis

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9
Q

spleen stores ___% RBC and ___% platlets

A

10-20% RBC

30% plts

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10
Q

T/F

we need the spleen to live

A

no

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11
Q

symmetric spleen enlargement

A

splenomegaly -
drug induced
congestion/torsion
immune mediate dz

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12
Q

asymmetric spleen enlargement

A

masses - neoplasia
hematoma
nodular hyperplasia

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13
Q

splenic torsion is most common with what

A

GDV
– or stretching of gastrosplenic ligament in previous GDV incident

large giant breed dogs

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14
Q

signs of acute splenic torsion

A 
acute abdomen normally due to gdv 
pain and shock 
distension
cvs collapse 
dysrhythmias 
DIC
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15
Q

signs of chronic splenic torsion

A 
intermittent for 2 weeks 
vomit and diarrhea 
anemia 
hematuria 
pu/pd
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16
Q

splenic torsion diagnostic test of choice

A

ultrasound

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17
Q

what will be seen on ultrasound to confirm splenic torsion

A

diffuse hypoechoic areas
intraluminal echogenic densities in veins
no flow in splenic vessels

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18
Q

what do rads show for splenic torsion

A

c shaped spleen
mid abdominal mass
effusion
gas bubbles in spleen

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19
Q

definitive tx for splenic torsion

A

exploratory laparotomy followed by splenectomy

**gastropexy too bc once spleen removed more likely to get gdv

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20
Q

T/F

derotate the spleen before splenectomy

A

FALSE NEVER DEROTATE THE SPLEEN BEFORE A SPLENECTOMY

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21
Q

T/F

ideally submit the spleen for histopath to ensure no underlying pathology to the torsion

A

true

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22
Q

survival to discharge of splenic torsion

A

91%

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23
Q

splenic torsion breed predisposition

A

GSD
danes
english bulldogs

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24
Q

what is not a cause ever of splenic torsion

A

neoplasia

need to differentiate tumor from torsion bc both show mass effect on rads

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25
T/F | splenic infarction is an emergency and surgery needs done immediately
false - do not race to surgery, usually infarction is due to a systemic problem, sort that out first
26
example of a splenic hyperactivity disorder
IMHA - diffuse hyperplasia
27
diagnostic dilemma with nodular hyperplasia
FNA cytology can look like cancer because there is poor sensitivity
28
sites of extrameduallary hyperplasia
nodular hyperplasia
29
T/F | most splenic nodular hyperplasia was an incidental finding and benign
true
30
rupture of capsule and parenchyma of spleen
blunt force - splenic trauma
31
how to treat splenic trauma
conservative mgmt compression bandage total splenectomy
32
#1 splenic neoplaia in dog
HSA
33
#1 splenic neoplasia in cat
mast cell tumor
34
what is the rule of 2/3
2/3 of dogs with a splenic mass will be malignant | and 2/3 of those malignancies will be HSA
35
risk factors for HSA
older >21 kg GSD, lab, golden, poodle presence of hemoperitoneum
36
presence of hemoperitoneum increases chance of splenic malignancy by what %
>80% NOT A RISK FACTOR IN SMALL DOGS THOUGH!!!!!!
37
why is the px so poor for HSA
nearly all cases have microscoping mets at the time of diagnosis 1-3 months
38
prognosis of HSA surgery alone
1-3 months
39
prognosis HSA | surgery + chemo/palladia
5-6 months 1 year in 10% of cases
40
HSA prognosis in surgery + chemo + immunotherapy
stage 1 (non ruptured spleen) - 425 days stage 2 (ruptured spleen) - no benefit
41
alternative adjunctive therapy in hsa
turkey tail mushroom - c versicolor | contains psp which causes cell cycle arrest at the g1/s checkpoint = more apoptosis of cancer cells
42
complete splenectomy 2 techniques
1. ligation of individual hilar vessels | 2. ligation of splenic and short gastric arteries
43
which splenectomy technique preserves branches to the pancreas and stomach
hilar dissection
44
limit of hemostatic clips
<4 mm vessels
45
what does LDS stand for
ligate divide stapler
46
electrothermal bipolar system can handle vessels of what size
up to 7mm without thermal damage | much faster and no foreign material is left behind
47
most common complication of splenectomy
hemorrhage
48
iatrogenic complications of splenectomy
pancreatitis/necrosis | gastric wall compromise
49
if this complication is present post splenectomy there is a 2x higher risk of death
ventricular arrhythmias monitor with 24 hour telemetry - holtor
50
what supplies blood to the left limb of the pancreas
branch of splenic a
51
what supplies blood to the right limb and body of the pancreas
cd pancreaticoduodenal a --> branch of cranial mesenteric a
52
enters duodenum at the major duodenal papilla with the bile duct
pancreatic duct **primary/only duct in cats
53
drains into the duodenum at the minor duodenal papilla in dogs
accessory pancreatic duct
54
drains the left lobe of the kidney
accessory pancreatic duct
55
drains the right lobe of the kidney
pancreatic duct
56
make glucagon
alpha cells
57
make insulin
beta cells -- 60-75% of islet cells
58
endocrine pancreas is made of what
islet of langerhans
59
delta cells
somatostatin
60
f cells
pancreatic polypeptide
61
T/F | pancreatitis is a very common and surgical disease
false - very common but not surgical
62
surgical biopsy technique of pancreas if diffuse disease is present
suture fracture - guillotine technique
63
indications of partial pancreatectomy
tumor removal
64
what two tools work best for ligations in partial pancreatectomy
hemoclips or bipolar cautery
65
what percent of the pancreas can be removed if the ramaining ducts are patent
80%
66
what is the most common and unpredictable complication of a partial pancreatectomy
pancreatitis - warn the owners
67
what is a complication of partial pancreatectomy if > 80-90% is removed
endocrine pancreatic insufficiency -- treat with insulin supplements
68
dr cavs tool of choice for pancreatic surgery
ligasure -- does not cause pancreatitis in its patients
69
devitilization of duodenum
if the pancreaticoduodenal arety (which arises from the cranial mesenteric artery) is damaged in surgery of the pancreas, the duodenum could be compromised
70
Collections of pancreatic secretions & cellular debris w/in fibrous sac or wall of granulation tissue
pancreatic pseudocyst
71
pancreatic pseudocysts lack this feature and therefore they are not true cysts
epithelial walls
72
T/F | pancreatic pseudocysts are often an incidental finding
true
73
pancreatic pseudocysts dx test of choice
ultrasound
74
pancreatic pseudocysts treatrment
only resect if ill from the disease, or debride and omentalize
75
usually secondary to bouts of pancreatitis
pancreatic abscess
76
lab results on pancreatic abscess
hyperbilirubinemia | elevated liver enzymes due to EHBO -- inflammed pancreas is causing duodenal papilla to swell shut
77
important to do post op for pancreatic abcess surgery patients
post gastric feeding tube
78
prognosis in pancreatic abscess patients
poor
79
exocrine pancreatic adenocarcinoma prognosis
``` 50-78% mets at dx sx resection if possible very poor 3 months in dogs <7 days in cats ```
80
insulinoma
beta cells continue to secrete insulin even though hypoglycemic
81
T/F | insulinoma is 100% malignant
false -- 90% but like...
82
what is whipples triad
way to dx insulinoma clinical signs associated with hypoglycemia fasting blood glu of 40 or lower relief of neuro signs when fed glucose
83
what is the most diagnostic for insulinoma
fasting insulin-glucose ratio insulin is HIGH despite hypoglycemia normal should be 5 to 26 insulinoma insulin levels exceed 70
84
diazoxide
oral hyperglycemia agent that inhibits pancreatic insulin secretion and glucose uptake by tissue
85
how does glucocorticoid therapy work to help medically manage insulinoma
increases hepatic glucose production and decreases cellular glu uptake
86
what diet to feed insulinoma patient
small frequent meals high protein complex carbs
87
gold standard surgical mgmt for insulinoma
partial pancreatectomy
88
Describes syndrome of gastric acid hypersecretion, gastrointestinal ulceration & non–β-cell pancreatic tumors
zollinger-ellison syndrome
89
gastrinoma diagnostic
high serum gastrin levels

surgery (18 decks)

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